By Brian Eckhouse (contact)

Tue, Mar 18, 2008 (2 a.m.)

For the 40,000 patients of the Endoscopy Center of Southern Nevada who must undergo tests for infectious diseases, the issue comes down to this: Just how much was it worth to risk my health?

The answer appears to be less than $100 per patient.

Here’s the math: A vial of propofol anesthesia costs between $60 and $94.70 and a single-use syringe is worth between a nickel and a half dollar.

Health officials allege the clinic’s managers, nurses and technicians reused syringes and tapped into the same vial of anesthesia on multiple patients. Regional and federal investigators are examining whether that practice enabled the clinic to bill Medicare, Medicaid and insurance companies. If so, the clinic could have collected multiple payments for the same vial of propofol.

Confirming that allegation requires poring over potentially hundreds of documents, but the method would be straightforward: seeing whether label numbers for the same vials were used to charge health care providers for multiple patients.

It’s still too early to tell whether the clinic’s managers defrauded the health care providers, said Conrad Hafen, the chief of the state attorney general’s criminal division. The investigation could last months.

“Insurance companies wouldn’t make a big deal out of it, but Medicare would,” said Dr. Michael Karagiozis, a former medical director of Nevada prisons who has been offering free hepatitis and HIV testing to the clinic’s uninsured former patients.

Propofol is worth $94.70 per vial, according to Web site Medscape.com, and that’s also the amount the clinic would have charged the health plans, Karagiozis said.

McKesson, a prominent San Francisco-based distributor of the anesthesia, refused to confirm that figure, however, and a University Medical Center spokesman said for an outpatient colonoscopy, UMC generally bills health providers $60 for a 200-milligram single-dose vial of propofol.

On most workdays, about 60 patients walked through the doors of the Endoscopy Center of Southern Nevada. If, as has been rumored, a single vial was used at least two times — but billed to each customer — that outpatient center would have amassed at least $430,000 extra in a year if it charged the health providers at UMC’s rate. If it followed Medscape.com’s figure, the main clinic would have collected at least $676,000 for vials used twice.

The clinic had six satellite offices, most of which offered some endoscopic procedures, so the grand total could be much higher.

It’s also possible that one vial was used for more than two people.

Then there are the reused single-use syringes. “Who knows how many times they reused them?” said Dennis Dunn, executive director of the Nevada AIDS Project.

It’s highly unlikely such reuse yielded a boatload of dollars for the clinic, but perhaps the ramifications of that practice could have been somewhat profitable.

Karagiozis suspects the reuse of syringes eliminated two succeeding steps: quality assurance and infection control. That, he believes, would have reduced or eliminated the need for at least one full-time nurse per office at an hourly salary of about $27, representing an annual savings of nearly $54,000 per office.

When it came to quality assurance and infection control at the center, “no one did that,” Karagiozis said.